Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials

Background The role of corticosteroids in the treatment of community-acquired pneumonia (CAP) remains uncertain. We conducted an updated meta-analysis to investigate the effectiveness and potential effect modifiers of adjunctive corticosteroids in patients with CAP. Methods The protocol of this meta-analysis was registered with PROSPERO (CRD42022354920). We searched MEDLINE, Embase, the Cochrane Library and trial registers from inception till March 2023 to identify randomized controlled trials (RCTs) investigating corticosteroids in adult patients with CAP. Our primary outcome was the risk of all-cause mortality within 30 days after randomization (if not reported at day 30, we extracted the outcome closest to 30 days). Risk ratios (RR) and mean differences (MDs) were pooled under a random-effects model. Results Fifteen RCTs (n = 3252 patients) were included in this review. Corticosteroids reduced the risk of all-cause mortality in CAP patients (RR: 0.69, 95% CI: 0.53–0.89; high certainty). This significant result was restricted to hydrocortisone therapy and patients with severe CAP. Additionally, younger patients demonstrated a greater reduction in mortality. Corticosteroids reduced the incidence of shock and the need for mechanical ventilation (MV), and decreased the length of hospital and ICU stay (moderate certainty). Conclusions Corticosteroids reduce the risk of all-cause mortality, especially in younger patients receiving hydrocortisone, and probably decrease the need for MV, the incidence of shock, and the length of hospital and ICU stay in patients with CAP. Our findings indicate that patients with CAP, especially severe CAP, will benefit from adjunctive corticosteroid therapy

COVID-19 and Obesity: When an Epidemic meets a Pandemic

Obesity has emerged as an epidemic worldwide, with an incidence of more than 40% in the United States and Europe. (2)The results of this study raise major concerns for Pakistan, where food is a major part of the culture. A healthy diet is often misunderstood as the consumption of desi ghee, sweets, and fatty foods.(3) The fast-food industry is growing rapidly in Pakistan, leading to greater consumption of foods rich in cholesterol and saturated fatty acids. According to a study by Pellegrini et al., lockdown has contributed to reduced exercise, anxiety, boredom, and unhealthy eating habits.(4) A higher percentage of body fat has increased the risk of multimorbidity which is considered as a risk factor of COVID-19.(5) A thorough online literature search was carried out on PubMed, and PakMediNet and no research was found assessing the correlation between obesity and COVID-19 in Pakistan. This shows the lack of attention given to this factor in the country. It is the duty of the physician to educate patients about the possible risks associated with obesity. This should be done keeping in view the patients’ socio-economic background, ensuring that the treatment plan is economically feasible. Patients should be advised to follow a balanced diet including vegetables and organic foods while avoiding junk food and frequent visits to restaurants. Adults and children should follow an active lifestyle where emphasis must be placed on daily exercise, a healthy breakfast, and a proper sleep schedule. It is imperative that patients are aware of the multimorbidity associated with obesity to lessen the burden on the health facilities in Pakistan and promote patient health. Continuous..

The COVID long-haulers: A letter to the Editor

Sir/Madam, Corona Virus disease 2019 (COVID-19) is a global pandemic that has affected over 174 million people and claimed over 4 million lives as of July 2021. (1) However, an aspect often overlooked is long COVID which includes signs and symptoms that develop or continue to persist in patients after acute COVID-19. (2) This has multi-organ system effects including cardiovascular, neurologic, pulmonary, psychiatric, and dermatologic manifestations (3). In a recent study conducted by H.E. Davis et al., Davis and colleagues surveyed 3762 patients with confirmed or suspected long COVID-19. The results showed the prevalence of 203 symptoms spanning over 10 organ systems. (4) The current guidelines place great emphasis on controlling the spread of this infection. While this is imperative, the long-term effects are often over-looked. Evidence shows that patients exhibit higher rates of morbidity and mortality in the six months following diagnosis of acute COVID-19 infection. (4) Long Covid has affected a significant number of health-care workers having a direct impact on the health system. Individuals who were physically fit and active prior to the infection find it increasingly challenging to perform basic daily tasks owing to brain fog.(5) The paucity of evidence across online databases regarding management of long COVID shows the lack of attention given to this factor

Efficacy and safety of direct oral anticoagulants with and without aspirin: A systematic review and meta-analysis

Background: Various anticoagulant therapies are prescribed to patients under physicians\u27 discretion and recently Direct Oral Anticoagulants(DOAC) have been under trials to evaluate their safety and efficacy. In addition to this, the regimen of DOACs and Aspirin is of keen interest as researchers continue to find an optimal regimen to treat blood clots in patients. This study is a systematic review and meta-analysis of randomized controlled trials and observational studies that asses the safety and efficacy of DOAC with and without Aspirin. Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to April 2021, for published and randomized controlled trials and observational studies in any language that compared dual (DOAC + ASA) therapy or mono (DOAC alone) therapy in patients with AF. The results from the studies were presented as risk ratios (RRs) with 95% confidence intervals (CIs) and were pooled using a random-effects model. Endpoints of interest included major bleeding, myocardial infarction (MI), major adverse cardiovascular events (MACEs), hospitalizations, all-cause mortality, and stroke. Results: The risk of major bleeding was significantly lower in the DOAC alone group compared with DOAC plus aspirin group. Non-significant results were obtained (P value greater than 0.05) for other outcomes establishing that DOAC monotherapy was not superior to the combined regimen in reducing the risk of MACE, Stroke, Hospitalization, Death. Conclusion: Among patients with NVAF (Non valvular Atrial Fibrillation) and VTE (Venous thromboembolism) receiving anticoagulation prophylaxis, in terms of safety profile our comparisons showed a statistically significant reduction in Major Bleeding in DOAC Alone group compared with DOAC Plus Aspirin

Efficacy of Sodium-Glucose Cotransporter-2 inhibitors in heart failure patients treated with dual angiotensin receptor blocker-neprilysin inhibitor: an updated meta-analysis

Background: Recent data suggest that the prevalence of heart failure has increased to approximately 23 million people globally. With increasing advancement in pharmacotherapeutics, Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) have garnered attention among clinicians to treat Heart failure with reduced ejection fraction (HFrEF) in diabetic as well as non-diabetic patients. Methods: MEDLINE, Scopus, Embase and Cochrane CENTRAL database were searched using relevant keywords and MeSH terms. Studies were considered only if they were randomized in nature and had a sample size >1000 HF patients. Results: Our comprehensive search strategy yielded 864 articles, of which three RCTs met the inclusion criteria with a total population of 9696. Pooled analysis revealed an association between the use of SGLT2i and decreased frequency of primary outcome irrespective of background ARNI use (HR 0.73, 95% CI [0.58-0.93], p = 0.0106; HR 0.73, 95% CI [0.66-0.81], p Conclusion: This meta-analysis provides substantial evidence, to safely use SGLT2i atop ARNI therapy in select HF patients to further improve outcomes.</p